Archive for April, 2013

There is lots of talk about waste in the health care system and how to fix it, market forces, personal responsibility, etc. etc. but the talk is always at a very high level. The abstract nature of it and the billions and billions of dollars involved make it hard to get an understanding of what is happening on a day to day, doctor to patient basis. Let’s try and change that.

About 10 weeks ago, I felt a little lump in my right breast just below the nipple. Not a big deal. No history of breast cancer in my family, no risk factors and I’m a guy so the risk is really minimal. I knew that I had a checkup in about 6 weeks so I figured I would try and remember to ask my primary care doctor then.

Six weeks go by, I go to my check up and just as I am getting ready to get dressed I say “Oh yeah, I have this little lump.” He looks at it and says, “hmmm it could be (some strange word) or (some other stranger word).” He asks me a few questions and says “lets have a radiologist take a look at it and see if you should have a mammogram or an ultrasound.” So I make the appointment for a week later.

I go see the radiologist and without even checking me out she immediately starts prepping me for the mammogram (guys, it ain’t fun) and then moves right onto the ultrasound. After both tests she says that there is nothing conclusive. She doesn’t think that it is anything bad but she can’t definitively rule anything out. She will send the results back to my primary care physician. I wonder how much it cost for this no answer.

A fews days later my primary care guy calls and says that he wants to refer me to a surgeon. I ask him if we can’t just watch it and see if it grows or changes. The answer is the typical medical hedge… we could but if it changes we might not get to it in time, blah, blah, blah. I am told that the surgeon will look at it and decide if it should be removed.

I make the appointment and as soon as I walk in the room the surgeon says “so what are we removing today?” I show him the lump and he says that he can’t tell anything without removing it. 10 minutes later a chunk of my chest about the size of 2 peas is removed, he shows it to me and says he will have the test results back in a week.

As I am heading home I am thinking how wasteful this whole thing has been just because I asked a simple question about a small lump.

From a financial standpoint, there was no copay for the checkup because we are trying to encourage those. There was no copay for the mammogram because we can’t fight a war on women. There was a $20 copay for the surgery visit because that isn’t sexist. I am sure this whole thing cost thousands and I paid $20. If I had to shoulder more of the cost would I have acted differently, yeah absolutely. I would have taken a much more active role in understanding my treatment, understanding what happens if… like what are the potential outcomes from the mammogram? What if they find that it is cancerous? What if the results are inconclusive (they never rule something out)? If you write out that decision tree, you end up in the same place – take it out. So why do the mammogram at all? Yesterday I found that cost the insurance company $444 (actually seemed cheap to me). That was money that didn’t need to be spent. There was no value added. We would have ended up at removal either way. (If I was paying I am not sure that I would have had it removed, but for $20 what they heck).

Doctors are following protocols because they are practicing defensive medicine and patients aren’t asking the right questions because they don’t have any skin in the game. In this case it was only $444 (probably more) but you multiply that by thousands and thousands of interactions a day/week/month/year and we are talking real money. ObamaCare can not solve this, it can only make it worse because the protocols will be even stricter taking common sense out of the process and making outcomes even worse.

What I will have to show for it all is a 1” scare on my chest. If anyone asks me about it I will tell them it was from a knife fight in my teens. Tough neighborhood on the Jersey Shore. Don’t rat me out.

Airlines have long been known for their crazy pricing rules. This has caused frequent travelers to do things like “Bridging Tickets” or getting off an itinerary at a hub to save money. However, recently with the rise of carriers like Jet Blue, Virgin America and Southwest pricing has become more rational. This is true domestically but today I had an experience that proved that it isn’t yet true internationally.

I booked a business class ticket from JFK to Paris to Boston on American Airlines that cost me $2900. I then tried to book a ticket for my daughter to join me on the Paris to Boston leg and the cost came back at $5400! Wait, are you kidding me?!? Almost twice the cost for half the trip.

But it gets weirder. American and British Airways code share so I could book her on the exact same plane but as a British Airways passenger at $2900. So, the same price for one way as for the round trip. Still not great but better.

How can they justify this? Who comes up with these things? For maybe the first time I have no answer.

Back in high school my track coach would often get on me about my sloppy block practice. He’d say “You aren’t setting up in the blocks properly. You’re rushing it, just going through the motions.” I’d say “Why does it matter right now? I’m not racing anyone today. I’ll do it right at the meet this weekend.”

“I’ll tell you why it matters” he’d say, sternly. “You play like you practice. Practice sloppy and you’ll play sloppy.”

You’ll play like you practice. You’re not going to be sharp unless you practice being sharp. I’ve heard this again over the years.

A few years ago I took a self-defense class. At one point in the class, we worked with fake handguns. We each had a partner and we had to work on scenarios where a gun might be involved.

The instructor repeatedly said, “When your turn is over, do not hand the gun to your partner. Instead, they’ll turn their back, and you’ll just drop it on the ground so they can pick it up and start the exercise over.”

That sounded weird. You’re right next to the person, why would you drop the gun so they had to pick it up?

Without having to ask why, the instructor explained himself: “If you practice handing the gun over to your partner now, you might end up handing the gun over to an actual assailant later. Don’t laugh, I’ve seen it happen.” Then he showed us surveillance camera footage of someone doing it in robbery.

It sounded ridiculous. Why would I ever give my gun to someone who’s attacking me? The answer is because if I practiced doing that earlier, I might do it later.

When humans are in stressful situations, we tend to fall back on our practice. If I practiced handing my gun over, I might mindlessly fall back on that when it mattered most. That would be bad.

Skip steps now, you’ll skip them later. Cut corners now, you’ll cut them later. You get used to what you do most of the time.

Anthony Bucci is one of the founders of RevZilla and Andrew gets him to tell the story of how he and his cofounders built the most successful e-commerce company that you have never heard of. RevZilla is a $50 million company that was built over the last 4 years with no outside money.

There are too many lessons to take away from this interview to list them all here so I will just mention one. Anthony talked about all the ways that they listened to their customers to learn why they came to the site, what got them to buy and in some cases why they didn’t buy.

Yesterday it was announced that Ron Johnson was dismissed as the CEO of JC Penney. He came into the company 17 months ago with great fanfare. Johnson was the genius behind the Apple Store and was going to change department store retailing as we know it. Opps.

Johnson’s main principle was that he was going to do away with heavy promotion and focus on everyday value. The lesson here should not be that the strategy was flawed. It should be that fundamental change like this is virtually impossible in a relatively healthy company. There is no compelling reason to take the risk. Employees don’t feel the change in their guts and customers aren’t behind the change. If this change is to happen it will come from a new entry into the market place. Only with a new entry will customers be taking control and making a positive choice to spend money there.

This morning I was at the local Midas listening to the manager talk to a frequent customer. He mentioned that sales go up by 30% over the summer. This happens because people open up their windows while they drive and they hear lots of new noises.

Why is this important? I don’t know… now. But somewhere down the road it might be an important little tidbit that leads to a new business idea. Good entrepreneurs are always talking little facts like this, combining them together and coming up with new business opportunities. You never know where these facts will come from so you have to always be listening.

The other value that little non obvious facts like this have is that when you weave them into your assumptions and drop them on your investors they can give you tremendous credibility.